Healthcare Provider Details

I. General information

NPI: 1588281273
Provider Name (Legal Business Name): LEATA A WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 W 23RD ST
NEW YORK NY
10011-2427
US

IV. Provider business mailing address

2104 CROSS BRONX EXPY APT 4C
BRONX NY
10472-5245
US

V. Phone/Fax

Practice location:
  • Phone: 347-573-1617
  • Fax:
Mailing address:
  • Phone: 347-573-1617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: